HemeOnc

Small Cell Lung Cancer

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Small Cell Lung Cancer

  • See Also
  1. Lung Cancer
  2. Non-Small Cell Lung Cancer
  • Background
  1. Accounts for 15-20% of Lung Cancers
  2. Central, large cancers with Lymphadenopathy
  3. Associated with paraneoplastic syndromes
  • Staging
  1. TNM Staging System
    1. Recommended by American College of Chest Physicians (ACCP)
    2. Staging Calculator
      1. http://staginglungcancer.org/calculator
  2. Veterans Administration Lung Study Group Classification System
    1. Limited: Lesion confined to ipsilateral chest
    2. Extensive: Metastases beyond ipsilateral chest
  • Management
  1. Available Therapy
    1. Chemotherapy
      1. Cisplatin (or Carboplatin if significant Chronic Kidney Disease)
      2. Etoposide (Etopophos)
    2. Radiation Therapy
      1. Consolidative Thoracic Radiation
        1. Considered in patients with residual localized Lung Lesions responding to Chemotherapy
      2. Cranial Irradiation
        1. Prophylactic for brain metastases in limited stage SCLC (reduces mortality)
      3. Localized palliative radiation
        1. Non-pulmonary metastases
      4. Whole brain Radiotherapy
        1. Brain metastases
  2. Limited stage
    1. Intent to cure management is associated with a 25% five year survival
    2. Chemotherapy with concurrent Radiotherapy (see above)
    3. Surgical resection of localized lesions may be indicated
  3. Extensive stage
    1. Five year survival approaches 0% (two year survival <10%)
    2. Chemotherapy with Immunotherapy for 4 to 6 cycles
    3. Maintenance Immunotherapy after initial cycles
    4. Radiation Therapy as above
  4. Other measures
    1. Cranial Irradiation
      1. Prophylactic cranial irradiation improves survival
      2. Auperin (1999) N Engl J Med 341:476-84 [PubMed]
  • References
  1. Kim (2022) Am Fam Physician 105(5): 487-94 [PubMed]
  2. Latimer (2015) Am Fam Physician 91(4): 250-6 [PubMed]